Redactado en Paralel

Saturday, January 8, 2011

Tuesday’s Fixes column was about conditional cash transfers, a new and highly successful large-scale anti-poverty program. It pays poor women as long as they meet certain responsibilities, like keeping their children in school and taking their families for regular medical care. It’s in use in Brazil, Mexico and 38 other countries.

Many commenters were skeptical that programs to help the poor could actually work in corrupt or badly governed nations. It’s certainly rare to find successful social programs in places where laws and institutions are very weak. But conditional cash transfers have features that allow them to work even in badly governed countries. It’s useful to look at what these features are.

These programs start with an idea that shouldn’t be unusual but, sadly, is — giving help to people who need it most. Social programs in many poor countries tend to benefit people who aren’t those in the greatest need. In health and education for instance, money is spent disproportionately on urban hospitals and universities, as these programs have powerful political constituencies. In most of the countries where they exist, conditional cash transfers are the first programs to truly focus on the poorest.

Before Brazil began Bolsa Familia, its only large social program was old-age pensions. These pensions only went to formal-sector workers; but the really poor of Brazil don’t have formal-sector jobs. Before Mexico had Oportunidades, its “help” for the poor took the form of a corrupt and wasteful network of shops selling subsidized milk, tortillas and bread. These programs were designed to please large dairy, corn and wheat farmers (something that should be familiar to anyone who takes a look at the U.S. farm bill.) Subsidies on bread? Poor Mexicans don’t even eat bread — they eat tortillas.

Mexico was able to change this because of the Tequila Crisis — the 1994 crash of the peso, when the economy contracted by six percent. A third of all Mexicans were living in extreme poverty, which meant their incomes did not cover even food alone. The government of Ernesto Zedillo knew that the food subsidy programs would do little to help. So it decided to find something better. Santiago Levy, then an undersecretary in the finance ministry, reasoned that subsidies were just an inefficient way to give the poor money — so why not give them money? At the time, this was considered a crazy idea. No other country did it.

Levy reasoned that the program would be much more effective if the money could be used as leverage. He set up a pilot project in a faraway state in secret — so as not to attract the attention of special interest groups. It worked. The pilot showed that it was logistically feasible to carry out the program; that families preferred cash over subsidies; that families did go to the doctor, and that, despite what skeptical Mexican cabinet members had warned, men did not beat up their wives, take the money and get drunk. Giving out cash proved to be hugely more efficient than the old food subsidies. Mexico found it could help many times more people with the same money it was spending on the old programs. One reason is that Opportunidades is careful to enroll only the people who need it most.

The program uses census data to find the poorest rural areas and urban blocks, and within those areas, gives out questionnaires about people’s income and possessions. What do you make? Do you have a dirt or cement floor? Do you own a hot-water heater? The homes of those who qualify are visited to verify their answers. Families must be recertified every three years, and according to Salvador Escobedo, the current director, about 10 percent leave each year — either because they have failed to complete their responsibilities, or they graduate and are no longer extremely poor. Mexico checks on whether families are keeping up with their responsibilities by having schools and clinics keep computerized track of attendance.

What about corruption in a country like Mexico? People will be corrupt when they have the chance. Amy from Los Angeles reports that in the Mexico City slum where she lived, people had to march with and vote for the locally-governing political party in order to get Oportunidades money. But the program aims to minimize the possibilities for patronage and corruption.

When I went back to Mexico, where I used to live, to report on Oportunidades in 2008, I was at first puzzled by the ubiquity of signs announcing “Oportunidades is a program of the federal government.” But there was a good reason for these signs — they were telling people that they shouldn’t give in to pressure from local leaders in order to get their payments. All program criteria are national – no decisions get made on the local level. If Amy is right, some local governments trick their people into thinking that they have influence. But it’s not many.

Oportunidades has no shops. No goods move, only money — and much of that electronically. The money is handled by banks; staff do not touch it. There is very little infrastructure — 95 percent of the program’s budget goes directly to beneficiaries. They get their cash, then patronize local businesses that sell food, clothing or school supplies. (The program is hugely popular with small businesses in poor towns. This is one way Oportunidades is helping even people who are not its beneficiaries, and one response to the complaint that simply redistributing money can’t possibly do anything.)

Susan Parker, an economist who has studied Oportunidades’ effects extensively, echoes a common perception that the program is remarkably clean. “It’s partly because of the design. The money gets to individuals — there isn’t any intermediary. It’s not the local politician who distributes money.”

To a rapturous welcome that conflated the religious and political, the populist Iraqi cleric Moktada al-Sadr delivered his support on Saturday for an Iraqi government that he had once derided as a traitorous tool of the United States and that his followers had battled in the streets of Iraq’s most important cities only a few years before.

The brief speech to thousands of followers was his first since returning last week after more than three years of voluntary exile in Iran, and was watched across the country for signs of a movement that portrays itself today as a far more disciplined, mature heir to the group that surged on the scene after the American invasion in 2003. The earlier incarnation, backed by its Mahdi Army militia, raucously articulated the voice of the urban poor, fighting the American military and then engaging in some of the worst sectarian carnage of the civil war.

Mr. Sadr’s challenge now is to reshape a powerful street movement into a political one, and to reconcile its self-image as the permanent face of opposition even as its ministers and deputies fill the ranks of the government.

In his 28-minute address, delivered in a warren of streets near his home in this sacred city, Mr. Sadr again sought to have it both ways, calling for the expulsion of American troops but allowing time for a withdrawal and offering support for a new government conditional on its effectiveness.

“We are with it, not against it,” he said, speaking forcefully and deliberately, with a confidence he once lacked. “The government is new, and we have to open the way for it to prove it will serve Iraq’s people.”

The crowd, rowdy and at times ecstatic, answered Mr. Sadr with chants of fealty. Some cried uncontrollably. Others, dangling from electricity pylons, thrust their fists into the air.

“Yes, yes, to His Excellency, the leader!” they shouted.

The scion of one of Iraq’s most prominent religious families, who inherited a grass-roots movement founded by his revered father in the 1990s, Mr. Sadr, now grayer, is perhaps the sole national figure who can compete with the prominence of Prime Minister Nuri Kamal al-Maliki. So far, their relationship has proved tumultuous, from allies to enemies to allies again, and Mr. Sadr’s speech outlined the pivots on which their relationship might turn.

He insisted that no American troops could remain in Iraq after 2011, a condition the United States has agreed to, and urged his followers to continue to resist the troops’ presence by any means. More cautiously, he suggested that he could withdraw support for Mr. Maliki if the government failed to address the most basic complaints of daily life here, particularly for the disenfranchised he claims to represent — shoddy roads, dirty water, leaking sewage and that persistent motif of post-Saddam Hussein Iraq, electrical blackouts.

But Mr. Sadr urged patience from his followers, and at the very least, his words seemed to mean that Mr. Maliki’s new government would have a grace period to act.

“We haven’t put a deadline on the government,” said Hazem al-Araji, a prominent lieutenant of Mr. Sadr’s. “We’re watching how it progresses, and after that we’ll decide.”

The occasion itself was street theater, with an audience stretching down the street to the turquoise-domed mosque of Kamil bin Zayid. On stage was the essence of a movement many believe could transform Iraqi politics, blending the centuries-old symbolism of Shiite sacrifice and martyrdom with a martial culture fostered by the American invasion and occupation.

Since reaching its nadir in 2008, after Mr. Maliki sent the Iraqi Army against its militia in Baghdad and southernmost Basra, with decisive help from the American military, the movement has returned to prominence, essentially by staking its claim to Iraqi politics. It made a strong showing in local elections in 2009. The next year, Mr. Sadr, who had long hedged his support for elections, called on his supporters to fully participate in the vote last March. They did, and in a feat of logistics and planning, the movement won 40 seats, emerging as a savvy player in the eight months of negotiations that followed. Its eventual support for Mr. Maliki was the key to his return for a second term.

At the speech on Saturday, the movement sought to convey a certain respectability, from sharply dressed security guards in gray suits to the punctuality of Mr. Sadr himself, who began talking precisely at 10 a.m., as scheduled. Cadres passed out Iraqi flags, soon overwhelming the crowd’s banners of pious slogans and portraits of Mr. Sadr. In fact, it was hard not to draw at least superficial comparisons to another Arab Shiite movement, Lebanon’s Hezbollah, both of whom navigate political, social and military identities and have built personality cults around their leaders.

There were even echoes of Hezbollah’s leader, Hassan Nasrallah, though Mr. Nasrallah remains far more dynamic and eloquent than Mr. Sadr. It was there in the mannerisms, the way each held a white handkerchief or excused himself to drink a glass of water. Each related to his audience the same way, too — speaking in a stentorian formal Arabic, only to lapse into slang when offering a joke or a casual aside.

“What’s up? Are you scared of the Americans?” Mr. Sadr asked the crowd from a 25-foot-high pulpit, draped in black, before leading them in a chant of “No, no to America.”

The crowd answered defiantly, raising their voices.

“You’re getting better,” he complimented them, with the wriest of smiles.

Most comparisons to Hezbollah go only so far, though, and many Sadrist officials point out the obvious: Just as Hezbollah was impossible without Israel’s 1982 invasion of Lebanon, so is Mr. Sadr’s movement without the assassination of his father on Mr. Hussein’s orders in 1999 and the American invasion and occupation four years later.

“We are a movement, we are not simply a party,” said Hakim al-Zamili, a Sadrist lawmaker who beat charges of murder, kidnapping and corruption from his time as an official in the Ministry of Health and who joined other Sadr officials at the event.

With that ambiguity, Mr. Zamili captured the challenge of an oppositional movement joining the mainstream, without surrendering the legions of supporters from hardscrabble neighborhoods, so zealous that some tried to stampede the stage.

Mr. Sadr’s speech offered few clues as to how he would cross that divide, going little beyond the reflexive nationalism and millenarian theology that has long served as the movement’s rallying cries. Nor did his lieutenants, some of whom volunteered a contradictory notion of being inside the government looking out, and from there looking back in at its performance.

“We’ll be watching them,” said Nassar al-Rubaie, the minister of labor and social affairs. “We’ll monitor the performance of this government.”

Intensified fighting and a larger troop presence in Afghanistan in 2010 led to the highest American combat casualties yet in the war, as the number of troops wounded by bullets, shrapnel and bombs approached that of the bloodiest periods of the war in Iraq.

But the available data points to advances in the treatment of the fallen, as the rate at which wounded soldiers who died reached a wartime low.

More than 430 American service members died from hostile action in Afghanistan last year through Dec. 21, according to official data released by the Pentagon last week at the request of The New York Times.

This was a small fraction of those struck. Nearly 5,500 American troops were wounded in action — more than double the total of 2,415 in 2009, and almost six times the number wounded in 2008.

In all, fewer than 7.9 percent of the Americans wounded in 2010 died, down from more than 11 percent the previous year and 14.3 percent in 2008.

The fatality rate declined even though many more troops patrolled on foot, exposing the force to greater dangers than in years past. Several doctors said the improvements came not from a single breakthrough but through a series of lessons learned over nearly a decade of fighting two wars, such as placing medevac helicopters closer to the fighting and the more extensive use of tourniquets.

Although fatality rates for wounded Afghan troops are not similarly available, doctors involved in their care said hospital records showed that they trail those of Western troops by a few percentage points, but have also fallen.

Several soldiers and those who care for them framed the improved survival rates as the grimmest sort of success. Many more troops — some missing multiple limbs or their genitals, or suffering brain damage — are being rescued from near death. But their wounds will be exceptionally difficult to overcome later as they try to resume work, and social and family lives.

Along with interviews with medics and military doctors, and a month spent by two journalists from The Times observing the collection and immediate treatment of troops suffering from a wide range of trauma, the data shows the results, in broad terms, of an evolving contest for wounded soldiers’ fates.

The contest pits a multilayered and expensive effort to keep troops alive against the sharply increased rate at which they suffer grievous injuries, some beyond what any medical system can heal.

A clear decline was evident: In 2005, 19.8 percent of wounded American soldiers died from their injuries. For the past five years in Afghanistan and Iraq, the fatality rates for wounded Americans have otherwise fluctuated between 9.4 and 14.3 percent.

(The data draws from a sample running into the tens of thousands; in 2006 in Iraq, for example, nearly 7,200 American troops were wounded by hostile action, more than 700 of them fatally.)

The statistics further served to reinforce consistent trends in the battlefield’s array of lethal hazards, and offered glimpses of wars within the war.

More soldiers in Afghanistan in 2010 were wounded by explosive devices (at least 3,615, compared to 828 troops reported to suffer gunshot wounds). But the higher fatality rates from gunshot wounds (12.9 percent versus 7.3 percent for wounds caused by bombs) made rifles and machine guns the most statistically deadly weapons.

Rocket-propelled grenades, for all their ferocious reputation, proved less of a threat. They wounded 373 American soldiers, of whom 13 — 3.5 percent — died.

No matter the improved odds, the data, like the field observations, illuminated that even the most determined efforts to cheat death could still be desperate — like the case of an Afghan soldier wounded on Dec. 9.

He was a disoriented young man on a stretcher with his uniform cut away, revealing wounds caused by a makeshift bomb.

His face was mashed. A tourniquet was cinched to his left leg, high by the hip. His abdomen swelled slightly from the bleeding within. From his torso rose the odor of burned flesh and hair.

The man worked with an American Special Forces team. Medics labored over him as the helicopter lifted from the dust, counting minutes in a race against time.

Medical workers attributed his improved chances to several factors, among them changes in training for soldiers who administer first aid, swifter movement of victims to hospitals made possible by more helicopters in the war, and shifts in procedures in operating rooms.